November 28, 2015

Professionalism in the health professions has been defined
as “the habitual and judicious use of communication, knowledge, technical
skills, clinical reasoning, emotions, values, and reflection in daily practice
for the benefit of the individual and community being served”.1
Professionalism serves as the basis of a contract between patients and healthcare
providers. Teaching professionalism has become a core concept in health
professional education, both in the didactic and experiential setting. However,
with advances in medical technology and increased
utilization of social media, it can be difficult to ensure that learners are maintaining
expected standards of professionalism.

Common Professional Lapses2

· Lack of initiative to assume responsibility / role

·Misrepresentation
or falsification of actions / information

·Failure
to take responsibility for actions

·Abuse
of privileges

·Inadequate
rapport with patients

·Insensitivity

·Disrespectful
language

·Inappropriate
interactions with groups

·Lack
of professional appearance

So how should lapses in professionalism be addressed and
corrected? One study published in the Academic Medicine Journal found that the
most effective methods were to address lapses in a timely manner and to provide
constructive feedback rather than punish the learner.3 Several tips
for approaching learners who have a lapse in professionalism have been
published.4

Modeling professional behavior is one of the key remediation
strategies.2 Learners mimic their preceptors, regardless of whether
the behavior is appropriate or not. Modeling involves all aspects of behavior
in the practice setting, from one-on-one interactions with other professionals,
patients, and caregivers; interprofessional team interactions, such as rounds
or peer discussions; maintaining privacy; appropriate documentation, and
adherence to timelines. Everyone must be mindful of the presence of learners in
the experiential learning settings, because learners are observing the actions
and demeanor all practitioners in order to help develop their own professional identity.
Modeling appropriate professional behavior by all members of the interprofessional
team serves as a link between didactic teachings and practical experience.4

The next tip is to acknowledge the hidden curriculum.Instructional regarding professionalism in
preclinical years is sometimes contradicted by unprofessional behaviors
observed in the clinical settings.5 These observations are not just
of the learners’ direct preceptor, but medical attending physicians, residents,
social workers, pharmacists, nurses and any other personnel involved in patient
care. It is important to acknowledge that learner’s may, at times, receive
conflicting messages regarding professionalism from their observations.Having conversations with the learner about
lapses in professionalism committed by more senior practitioners can be a
simple way to address inappropriate professional behavior so that the learner
isn’t left with the impression that such behaviors are acceptable.

It is also important to be familiar with the institution
policies and procedures for addressing lapses in professionalism.4
The institution or department policy should have clear procedures for how
information regarding lapses should be documented, who should receive the information,
and what the potential consequences are. This is beneficial for both the
learner and the preceptor, as the expectations and consequences are clearly
outlined at the beginning of the learning experience.

The next set of tip involves data gathering and fact
checking. It is very important to ensure you have objective evidence to support
the perceived lapses in professionalism.4Because learners often model their behaviors
based on observations, it is important to gather information from multiple
sources that have had interactions with the learner and can provide first
person testimony, documentation, or evidence of the learner’s behavior. This
can also help to identify potential reasons behind the lapse, as well as ways
to address the lapse in the future.

It’s important to have an experienced educator or mentor
available for advice when needed. This person should have experience with
learners in different types of situations. It’s important to clearly articulate
your questions to your peer, as well as state how the learner expectations
where outlined. The trusted advisor can provide perspective and help develop
the plan for providing feedback to the learner.4

Next the preceptor should be ready to have a conversation
with the learner regarding their professional behaviors. During the encounter,
remember to be a good listener. Learners should have the opportunity to voice
their perceptions of the situation. At times, perceived lapses may be a result
of lack of understanding or misinterpretation of their role. Be sure conduct the conversation in an
environment where the learner feels safe, somewhere private and discrete so
that the learner does not feel that they are being publicly reprimanded. Be care
in your word choices. Use a non-accusatory approach. You don’t want the learner
to feel attacked or become defensive about their actions. The preceptor should
present to the learner the objective evidence gathered, then allow time for the
learner to reflect. The preceptor should provide direct and explicit feedback
to the learner. The learner should leave the encounter with a clear
understanding of why the behavior is considered a lapse and how to improve in the
future.4

Finally, the preceptor should close the loop.4 Preceptors
should help the learner make a behavior change by ensuring the learner develops
his/her decision-making skills. The preceptor can present hypothetical
situations and have the learner voice the steps necessary to make a
decision.This is a helpful way to
develop these problem-solving and ethical reasoning skills. Helping learners to
recognize the impact that their behaviors may have on patient outcomes can also
be motivational.4 Learners should be encouraged to continuously
think about professional values and ways to develop their skills.

Know when to call for back-up. There are always going to be
situations or learners who are difficult or when unexpected issues emerge. It’s
important for the preceptor to know his/her limitations.

Addressing lapses in professional behaviors can daunting. The
right tools can help preceptors feel more confident in addressing these lapses.
Preceptors should have a plan to effectively address professional lapses in a
timely fashion. Professionalism is vital to building a trusting
patient-provider relationship, so it is important that future practitioners are
aware of the importance of professionalism and how lapses can negatively impact
relationships with patients and colleagues.

November 24, 2015

You have probably taken a personality test.It might have been as simple five question
online quiz or as involved as the Myers-Briggs personality inventory.Most people are curious learn more about
their personality type.But have you
ever taken a learning style questionnaire?Everybody has their own learning style, and these questionnaires were
developed to help shed some light on how we best learn. Knowing your learning style can help you learn
more successfully; and as teachers, it is important to help your students understanding
their learning styles. There are a few
different types of surveys out there which provide “insight into the ways
learners perceive, interact with, and respond to the environment in which
learning occurs.”1

First, let’s talk about the different learning styles known
as VAKT (which stands for Visual, Auditory, Kinesthetic-Tactile).These learning styles related to how we learn in response to environmental stimuli.2Visual
learners learn best through interpreting graphics, body language, and
facial expressions during lessons. Visual learners often prefer sitting at the
front of the room to have a clear view of the presenter. And they tend to like diagrams,
illustrated text books, videos, and colorful handouts.Auditory
learners learn best through lectures, discussions, talking things through
problems, and listening to what others have to say.They can interpret the underlying meanings of
speech based on tone, pitch, and speed of the presenter’s voice. Auditory learners also like to record lectures
and listen to them later.Kinesthetic/tactilelearners learn best through a hands-on
approach. They may find it hard to sit through
a long lecture without some sort of activity in the middle.

Kolb’s Learning Style Inventory (LSI) combines two major cognitive
dimensions:the active-reflective
dimension and the abstract-concrete dimension.3From these dimensions, Kolb developed four
learning styles:diverger, assimilator,
converger, and accommodator.However,
research has shown that the LSI had low predictive validity and thus, the
Learning Style Questionnaire (LSQ) was subsequently developed by Honey and
Munford. Similar to Kolb’s Learning
Style Inventory, the Honey and Munford learning style questionnaire reveals four distinct preferences:Activist, Theorist, Pragmatist, and
Reflector.Honey and Munford believe
that individuals move between the four different preferences depending on the
situation and their level of expertise in the subject, rather than being locked
into one.4These learning
style tests include not only perception but also information processing rather
than just focusing on the environmental stimuli (such as with the VAKT learning
styles test).Activists are students who enjoy being challenged by new
experiences and being involved in projects with others.Theorists
prefer to think through problems systematically and understand the theories behind
what is being taught.Pragmatistslearn best when they are
able to apply what they learn to real life stituations.These students may benefit most from case
studies and discussions about what others have experienced in the real world.Reflectorslearn by observing activities and drawing conclusions about what they see; they
prefer receiving feedback from others and having time to review concepts prior
to applying them.5

Anthony Grasha and Sheryl Reichmann developed the Grasha-Reichmann Learning Style Scales
in 1974 to determine college students' preferences for classroom participation.The questionnaire has a series of statements
that the student can rate from 1 (strongly disagree) to 5 (strongly agree)
including: “I enjoy discussing my ideas about course content with other
students,” “I can determine for myself the important content issues in a
course,” and “I prefer to work on class related projects by myself.”6The responses are then tallied up to
determine what preferred social learning preferences the student has:Independent, Dependent, Avoidant,
Participant, Collaborative, and Competitive.Independent students prefer
to think for themselves and work on their own.Dependent students generally
only learn what is required of them and look for specific guidelines on what to
do and how to do it.Avoidant types are not enthusiastic
about learning the content and will require a lot of coaxing to complete
activities.Participant students enjoy taking responsibility for getting the
most out of their lesson.Collaborative describes students who
enjoy sharing their ideas and working in groups.Competitive
students learn content in order to achieve a better grade than their peers or
to receive the teacher’s praise.7

There are many questionnaires available that can inform
students about the learning strategies that work best for them.These questionnaires focus on different learning
style preferences and probably yield the best results when a few questionnaires
are used.By figuring out which VAKT
learning style learners are most drawn to, they will understand what type of environmental
stimuli they learn best from.Using
Honey and Munford’s questionnaire, learners will understand how to best process
the content delivered to them.By
utilizing the learning scale developed by Grasha and Reichmann, learners can determine
whether they work best in groups or alone.By putting all of these learning scales together, students can better
understand how they learn, can select courses that use methods they are more
likely to enjoy, and adjust their study habits to learn most effectively!

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